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<title>.::Bastanteo::.</title>
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<body style="background:#666">
<div style="width:700px; height:500px; margin:0 auto; background:#eee; font-family:Tahoma, Geneva, sans-serif;">
<div style="width:430px; height:50px; margin:0 auto; padding:20px; text-align: center; font-weight: bold;">BASTANTEO</div>
<div style="width:600px; height:350px; margin:0 auto;">
  <form id="form1" name="form1" method="post" action="">
    <table width="500" border="0" align="center">
      <tr style="width:450px;">
        <td width="181">CLIENTE</td>
        <td colspan="2"><label>
          <input name="textfield" type="text" id="textfield" size="30" />
        </label></td>
      </tr>
      <tr>
        <td>Grupo</td>
        <td colspan="2"><input name="textfield2" type="text" id="textfield2" size="30" /></td>
      </tr>
      <tr>
        <td>Poderes</td>
        <td colspan="2"><select name="select" id="select">
          <option>CHCO</option>
          <option>EFERT</option>
        </select></td>
      </tr>
      <tr>
        <td>Tipo de Intervención</td>
        <td colspan="2"><select name="select2" id="select2">
          <option>Activo</option>
          <option>Pasivo</option>
        </select></td>
      </tr>
      <tr>
        <td>Hasta</td>
        <td colspan="2">&nbsp;</td>
      </tr>
      <tr>
        <td>En combinación</td>
        <td colspan="2"><select name="select3" id="select3">
          <option>A</option>
          <option>B</option>
          <option>C</option>
        </select></td>
      </tr>
      <tr>
        <td>Vigencia</td>
        <td colspan="2"><input name="textfield3" type="text" id="textfield3" size="20" /></td>
      </tr>
      <tr>
        <td> </td>
        <td colspan="2">&nbsp;</td>
      </tr>
      <tr>
        <td>&nbsp;</td>
        <td width="92"><label>
          <input type="submit" name="button" id="button" value="Registrar" />
        </label></td>
        <td width="125"><input type="submit" name="button2" id="button2" value="Cancelar" /></td>
      </tr>
    </table>
  </form>
  <div style="padding:40px 0  0 0;">
    <table width="500" border="1" align="center">
      <tr>
        <td bgcolor="#999999">Grupo</td>
        <td bgcolor="#999999">Poder</td>
        <td bgcolor="#999999">Forma</td>
        <td bgcolor="#999999">Hasta</td>
        <td bgcolor="#999999">Combinacion</td>
        <td bgcolor="#999999">Vigencia</td>
      </tr>
      <tr>
        <td>A</td>
        <td>CHCO</td>
        <td>S. Firma</td>
        <td>50000</td>
        <td>---</td>
        <td>12-12-12</td>
      </tr>
      <tr>
        <td>B</td>
        <td>EFRET</td>
        <td>Combin</td>
        <td>3000</td>
        <td>A</td>
        <td>3-2-13</td>
      </tr>
    </table>
  </div>
</div>
</div>
</body>
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